Alice Dreger and Ellen K. Feder from Bioethics Forum have unearthed a 2007 study in which a doctor from Cornell University defends the practice of surgically cutting girls' clitorises. Disturbing, but his follow-up treatment is even worse.

The paper in question appeared several years ago in the Journal of Urology. "Nerve Sparing Ventral Clitoroplasty: Analysis of Clitoral Sensitivity and Viability" by Jennifer Yang, Diane Felsen, and Dix P. Poppas described in dry clinical terms how Poppas believes he has developed a way to remove part of a girl's clitoris without damaging their ability to have sexual sensation. Though the practice sounds a lot like female genital mutilation (and in strictly literal terms, it is) Poppas is not cutting into their genitals to make women less sexually inclined - he's doing it because someone decided that their clitorises were too big. Usually, this someone is a physician. With the parents consent and at the physician's suggestion, Poppas cuts into the shaft of the clitoris and removes a section, without, he hopes, damaging the nerves.

Though the entire study should raise about a thousand red flags, Dreger and Feder focus on Poppas's technique for determining whether the children retain sensitivity in the area after he has performed the surgery. In order to test sensation in their nerves, he takes a cotton-tip applicator and/or a "vibratory device" and stimulates the girl, who is usually between age 6-10, asking her whether she is able to feel his motions. More specifically:

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Using the vibrator, he also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch. Yang, Felsen, and Poppas also report a "capillary perfusion testing," which means a physician or nurse pushes a finger nail on the girl's clitoris to see if the blood goes away and comes back, a sign of healthy tissue. Poppas has indicated in this article and elsewhere that ideally he seeks to conduct annual exams with these girls. He intends to chart the development of their sexual sensation over time.

At the age of six, these girls are old enough to remember their visits to Poppas's office. They are old enough that the memory of a much older physician stimulating them with a vibrator will be easily accessible in later years. And Poppas wants to do this annually.

Furthermore, Poppas's stimulation technique is virtually unheard of among urologists. Dreger and Feder asked around, and were unable to find a single doctor who performed similar tests on their young patients. They suggest that the vibrator sessions may cause lasting psychological damage - and for what reason? To make a clitoris a more acceptable size? There is no evidence that having a larger-than-average clitoris affects girls' psychological development, and many doctors agree that there is absolutely no medical reason to perform the surgery in the first place. As Dreger and Feder point out, many parents sign on to whatever their child's doctor says, out of fear of withholding medical treatment. If the doctor says it's too big, then by all means, cut it out! Though Poppas argues that this will help the psychosocial development of the child, there is no evidence that having a big clitoris puts them at risk in the first place. Many parents do not know this, and Poppas's website does not provide antiquate information on the subject.

Many of us happen to think "normal" sexual development is actually likely to be thwarted by having parts of your genitals taken away without your consent, and thwarted by follow-up exams like the ones we are describing. Ellen and I have gotten to know hundreds of adults born with sex anomalies who went through these medical scenes growing up. Many have told us that the genital displays involved in the follow-up exams were more traumatic than any other part of the experience. Indeed, when I once asked a group of women with androgen insensitivity syndrome what they wanted me to work on primarily in my advocacy work, they said stopping the exams, particularly those in which med students, residents, and fellows parade through to check out the surgeon's handiwork.

She also points out another problem with the procedure: in cutting the "shaft" of the clitoris, Poppas is removing the section that many girls use to masturbate. The "nerve-sparing" technique leaves the glans (tip) intact, but takes chunks out of the shaft. Since many women find their clitoral glans too sensitive, they tend to masturbate by stroking the shaft (Dreger writes: "Think about it... How do men masturbate?"). Even if he is able to save the nerves of the glans, which isn't always the case, Poppas is removing an important part of the female genitals. For a purely aesthetic reason.

And the matter is even further complicated by the fact that large clitorises have been linked to an increased probability that the girl will later identify as gay. Dan Savage writes:

There's another disturbing reason this surgery is being performed: girls with large clitorises are more likely to identify as lesbians when they grow up. Needless to say (or maybe not-so-needless): carving up a girl's clitoris does nothing to change the underlying hormonal and genetic factors that contribute to lesbian orientation and identity. Big clits don't make lesbians-lesbians sometimes make big clits. These surgeries are partly motivated by out-and-out homophobia, by the belief that "fixing" a large clit somehow prevents lesbianism. (Larger penises correlate positively with gayness in males but no one is out there shortening boys' penises.)

Basically, doctors have decided that, despite the lack of evidence to support their position, large clits are bad and need to be resized. The surgery has many risks that are not listed on Poppas's website, including nerve damage, incontinence, urinary tract infections and inability to experience orgasm. Participation in his study may also put girls at risk for serious psychological trauma. And for what? Though Poppas is attempting to preserve nerves rather than eradicate them, what he is doing is still mutilation. This medically unnecessary practice is a form of female genital mutilation. And we should recognize it as such.